You remember the e-mails five years ago. They were all the same, junking up our in-boxes with bullet lists of how great things were going in Iraq — the exact number of new schools built, the number of Iraqis happily employed, the number of cell phones beeping everywhere (including, presumably, those used to detonate roadside bombs). It was all absurd stuff, too glib and pointless to verify. The war’s conduct was going from bad to criminal but made to look like Valley Forge on the Tigris.

The e-mails were deranged. Their orchestration wasn’t. It detracted the debate at a crucial time, making coverage of the war more of an issue than the war itself. Delusions like that, culminating in the vilification of decorated and mutilated war heroes like John Kerry and Max Cleland as cowards, were enough to secure George Bush’s re-election. His supporters’ regret was plentiful in subsequent years. Like those e-mails’ veracity, it counted for nothing. The damage was done.

The same tactics — the same hysterics, the same floods by e-mail and TV or radio shout-show demagoguery, the same vilification — have commandeered the health-care reform debate. Whatever is happening in those town hall meetings isn’t about reform. It’s about preventing the national discussion from getting reform to a point of no return, at which point reform’s opponents are lost. It happened with the New Deal, with the Civil Rights Act, with Medicare, the Clean Air Act. There’s a point where the question is no longer whether those great lurches forward should take place (after being resisted for decades), but how they will take place.

Short of national emergencies or crushing congressional majorities, as in the New Deal and Great Society periods, Congress and the president have to do their work in concert to ensure success. The Clean Air Act of 1990 was finally adopted by a Democratic Congress and a Republican president only after endless public hearings and compromises — not parachuting town hall meetings. If that were ahead for health care, maybe opposition would have been better neutralized. But the manufactured rage over phantom fears is ensuring that the reform package won’t get that far.

There’s plenty to debate in the proposal — fiercely and legitimately. Should small businesses be exempt from the requirement that employers provide insurance? Is the definition of a small business fair? Should the self-employed be made to comply with the same mandates? Is a public-insurance option too expensive? Not broad enough? If a single-payer system works for the elderly, for veterans, for government employees and the poor, why not try it for the rest of us? Should the rich be surtaxed?

That’s not what the town hall brigades are shouting over. They’re fueled up on the lies of those mass e-mails that presume to list, page by page, the horrors of the health-care bill, whether it’s the fabrication about “death panels,” the one about government workers dictating parenting to mothers, or health care being provided to undocumented immigrants (too good to be true, that one). Reporters fuel the lies by couching them in the false objectivity of reporting “both sides of the story” instead of tracking down the story’s origin — the bill’s content, which is nowhere near its detractors’ imagination or many reporters’ second-hand and third-rate reporting. You don’t compromise fact in the name of balance.

I have one of those emails listing some 50 items “that are downright unconstitutional” in that bill, referenced by page number. A three-second Google search under “health care bill” takes me to the original bill and listed page numbers, showing the majority of claims to be verifiably false. Few aren’t, like the one about taxing businesses who don’t offer health care to their employees. Fine. Those are arguable, factually based debating points (I happen to agree with the mandate). But those aren’t the items tickling the throats of town-hall maniacs. (Feel free to e-mail me one of those claims or fears. I’ll demolish either for you, free, time and volume permitting.)

This isn’t about dissent, either. When people shout some of the things they do to lapping cameras (“I want my America back!” “Obama is destroying the country!” “Socialism! “Communism!”) I’m reminded of something more senseless than the Iraq war fantasists. I’m reminded of those 9/11 conspiracy theorists who insist Bush and his friends planned 9/11, or of people who think the “Protocols of the Elders of Zion” — the anti-Semite’s bible — explains the world. This is mass-hysteria territory. Hatreds and prejudices that have nothing to do with health care are being harnessed to defeat the country’s most urgent need, and with it maybe its latest champion: A twofer to satisfy partisans and skinflints. By the time facts are sorted from fools, it’ll again be too late.